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Wilke MH, Preisendörfer B, Seiffert A, Kleppisch M, Schweizer C, Rauchensteiner S. Carbapenem-resistant gram-negative bacteria in Germany: incidence and distribution among specific infections and mortality: an epidemiological analysis using real-world data. Infection 2022; 50:1535-1542. [PMID: 35639286 PMCID: PMC9705437 DOI: 10.1007/s15010-022-01843-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Infections with carbapenem-resistant gram-negative bacteria (in Germany classified as 4MRGN) are a growing threat in clinical care. This study was undertaken to understand the overall burden of 4MRGN infections in Germany in the context of a Health Technology Appraisal (HTA) for Ceftazidime/Avibactam (CAZ/AVI). Besides, the incidences mortality was an endpoint of interest. METHODS To assess infections with carbapenem-resistant gram-negative bacteria and related mortality, three different data sources have been used. From the German statistics office (DESTATIS) data have been retrieved to obtain the overall frequency these pathogens. Via two other databases, the German analysis database (DADB) and a Benchmarking of > 200 hospitals in a representative sample (BM-DB), the distribution of the infections and the mortality have been analyzed. RESULTS DESTATIS data showed a total of 11,863 carbapenem-resistant gram-negative bacteria codings, of which 10,348 represent infections and 1515 carriers. The most frequent infections were complicated urinary tract infections (cUTI) (n = 2,337), followed by pneumonia (n = 1006) and intra-abdominal infections (n = 730). A considerable amount of patients had multiple infections in one hospital episode (n = 1258). In-hospital mortality was 18.6% in DADB and 14.3% in the BM-DB population, respectively. In cases with additional bloodstream infections, DADB mortality was correspondingly higher at 33.0%. DADB data showed an incremental mortality increase of 5.7% after 30 days and 10.0% after 90 days resulting in a cumulative 90 day mortality of 34.3%. CONCLUSIONS Infections with carbapenem-resistant gram-negative bacteria are still rare (6.8-12.4 per 100,000) but show a significant increase in mortality compared to infections with more sensitive pathogens. Using different data sources allowed obtaining a realistic picture.
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Affiliation(s)
- Michael H. Wilke
- Medical School Hamburg (MSH), Am Kaiserkai 1, 20456 Hamburg, Germany
| | | | - Anna Seiffert
- Gesundheitsforen Leipzig GmbH, Hainstraße 16, 04109 Leipzig, Germany
| | - Maria Kleppisch
- Health Technology Assessment and Outcomes Research (HTA&OR), Health and Value Germany, Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
- Hospital Business Unit Germany, Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
| | - Caroline Schweizer
- Health Technology Assessment and Outcomes Research (HTA&OR), Health and Value Germany, Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
- Hospital Business Unit Germany, Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
| | - Stephan Rauchensteiner
- Health Technology Assessment and Outcomes Research (HTA&OR), Health and Value Germany, Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
- Hospital Business Unit Germany, Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
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Hanses F, Dolff S, Trauth J, Seimetz M, Hagel S. A Multicentre, Prospective, and Retrospective Registry to Characterize the Use, Effectiveness, and Safety of Dalbavancin in German Clinical Practice. Antibiotics (Basel) 2022; 11:antibiotics11050563. [PMID: 35625206 PMCID: PMC9138055 DOI: 10.3390/antibiotics11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
The antibiotic dalbavancin is approved for intravenous treatment of adults with acute bacterial skin and skin structure infections. This study aimed to observe the use, effectiveness, and safety of dalbavancin in clinical practice in Germany. It was a multicentre, prospective, and retrospective registry and consecutively enrolled patients treated with dalbavancin. Each patient was observed from the first to the last dose of dalbavancin, with a 30-day follow-up. Patient inclusion was planned for 2 years, but was terminated early due to low recruitment. All analyses were descriptive. Between November 2018 and December 2019, nine patients were enrolled. Only three patients were treated for the approved indication. Outcome was assessed by the physicians as ‘success’ in five (55.6%) patients, ‘failure’ in one (11.1%) patient, and non-evaluable in three (33.3%) patients. Although the success rate of dalbavancin was lower than reported previously, this may be due to the severity of underlying infections and patients’ high Charlson Comorbidity Index. None of the two reported adverse events were considered related to dalbavancin. These findings were in line with real-world data for dalbavancin from other countries, supporting the drug’s positive benefit–risk profile and suggesting frequent off-label use in German routine practice.
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Affiliation(s)
- Frank Hanses
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany;
- Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany;
| | - Janina Trauth
- Division of Infectious Diseases, Department of Internal Medicine II, University Hospital Giessen and Marburg, Klinikstraße 33, 35392 Giessen, Germany;
| | - Michael Seimetz
- Advanz Pharma Germany GmbH, Herforder Str. 69, 33602 Bielefeld, Germany;
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital—Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
- Correspondence: ; Tel.: +49-3641-9-324590
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Taylor K, Williamson J, Luther V, Stone T, Johnson J, Gruss Z, Russ-Friedman C, Ohl C, Beardsley J. Evaluating the Use of Dalbavancin for Off-Label Indications. Infect Dis Rep 2022; 14:266-272. [PMID: 35447884 PMCID: PMC9026399 DOI: 10.3390/idr14020032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
(1) Background: Dalbavancin is a long-acting lipoglycopeptide antibiotic approved for skin and soft-tissue infections. Post-marketing experience suggests dalbavancin is being used for off-label indications that normally require long-term intravenous (IV) antibiotics; however, data assessing this off-label usage are limited. The purpose of this study was to evaluate the real-world efficacy, safety, and financial impact of off-label dalbavancin use. (2) Methods: This is a retrospective, observational study conducted within a 4-hospital health system. Adult patients who received dalbavancin from January 2018 to January 2021 for an off-label indication were included. The primary outcome was clinical success at 90 days. Secondary outcomes included safety (nephrotoxicity and hepatotoxicity). A pharmacoeconomic analysis was performed by comparing the cost of dalbavancin to the anticipated cost of patient stay if standard IV therapy was given. (3) Results: Forty-eight patients met study criteria. Indications included osteomyelitis (54%), endocarditis (23%), bacteremia (15%), and prosthetic joint infection (8%). The predominant organism was S. aureus (60%), with 42% caused by methicillin-resistant S. aureus. Overall, 41 (85%) patients achieved clinical success at 90 days, including 85% with osteomyelitis, 82% with endocarditis, and 86% with bacteremia. There were no instances of nephrotoxicity or hepatotoxicity. Estimated cost avoidance per patient was USD 5313 and USD 1683 if traditional IV therapy would have been completed in the hospital and skilled nursing facility, respectively. (4) Conclusion: Dalbavancin was associated with a relatively high success rate for the treatment of off-label indications and may be a cost-effective alternative to traditional IV antibiotic therapy.
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Affiliation(s)
- Katherine Taylor
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Correspondence:
| | - John Williamson
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - Vera Luther
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - Tyler Stone
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - James Johnson
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - Zachary Gruss
- ProMedica Toledo Hospital Department of Pharmacy, Toledo, OH 43606, USA;
| | - Courtney Russ-Friedman
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - Chris Ohl
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - James Beardsley
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
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de Pablo-Miró M, Pujol-Ruiz S, Iftimie S, Arenas-Miras MDM, López-Montesinos I, Duran-Jordà X, Anglès A, Grau S, Horcajada JP. Comparative Analysis of Dalbavancin versus Other Antimicrobial Options for Gram-Positive Cocci Infections: Effectiveness, Hospital Stay and Mortality. Antibiotics (Basel) 2021; 10:antibiotics10111296. [PMID: 34827234 PMCID: PMC8614661 DOI: 10.3390/antibiotics10111296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Dalbavancin is a new antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococci, and offers the possibility of administering intravenous therapy once weekly in an ambulatory setting. We conducted a multicenter observational case-control study, comparing all patients who received dalbavancin (cases) with hospitalized patients who were treated instead with daptomycin, linezolid or vancomycin (controls), based on clinical diagnosis, main microorganism involved, and age. The primary outcome was the length of hospital stay after starting the study antimicrobial. Secondary outcomes were 7-day and 30-day efficacy, 30-day mortality, 90-day recurrence, 90-day and 6-month hospitalization, presence of adverse events and healthcare-associated infections; 161 patients (44 cases and 117 controls) were included. Bivariate analysis showed that dalbavancin reduced the total length of hospital stay (p < 0.001), with fewer 90-day recurrences (p = 0.005), 6-month hospitalizations related to the same infection (p = 0.004) and non-related hospitalizations (p = 0.035). Multivariate analyses showed that length of hospital stay was significantly shorter in patients treated with dalbavancin (−12.05 days 95% CI [−17.00, −7.11], p < 0.001), and 30-day efficacy was higher in the dalbavancin group (OR 2.62 95% CI [1.07, 6.37], p = 0.034). Although sample size of the study may be a limitation, we can conclude that Dalbavancin is a useful antimicrobial drug against Gram-positive infections, including multidrug-resistant pathogens, and allows for a remarkable reduction in length of hospital stay with greater 30-day efficacy.
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Affiliation(s)
- Mar de Pablo-Miró
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
- Faculty of Health and Life Sciencies, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Sergi Pujol-Ruiz
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
- Faculty of Health and Life Sciencies, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Simona Iftimie
- Infectious Diseases Service, Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain;
| | - María del Mar Arenas-Miras
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
| | - Inmaculada López-Montesinos
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
| | - Xavier Duran-Jordà
- Statistics Service, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
| | - Albert Anglès
- Documentation Service, Hospital del Mar, 08003 Barcelona, Spain;
| | - Santiago Grau
- Faculty of Health and Life Sciencies, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- Pharmacy Service, Hospital del Mar, 08003 Barcelona, Spain
- REIPI (Red Española de Investigación en Patologías Infecciosas)—ISCII (Instituto de Salud Carlos III) Spanish Network for Research in Infectious Diseases, 28029 Madrid, Spain
| | - Juan P. Horcajada
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
- Faculty of Health and Life Sciencies, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- REIPI (Red Española de Investigación en Patologías Infecciosas)—ISCII (Instituto de Salud Carlos III) Spanish Network for Research in Infectious Diseases, 28029 Madrid, Spain
- Correspondence:
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Gatti M, Andreoni M, Pea F, Viale P. Real-World Use of Dalbavancin in the Era of Empowerment of Outpatient Antimicrobial Treatment: A Careful Appraisal Beyond Approved Indications Focusing on Unmet Clinical Needs. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:3349-3378. [PMID: 34376971 PMCID: PMC8349200 DOI: 10.2147/dddt.s313756] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/21/2021] [Indexed: 12/26/2022]
Abstract
Dalbavancin is a novel, long-acting lipoglycopeptide characterized by a long elimination half-life coupled with excellent in vitro activity against multidrug-resistant Gram-positives. Although it is currently approved only for the treatment of acute bacterial skin and skin structure infections, an ever-growing amount of evidence supports the efficacy of dalbavancin as a long-term therapy in osteomyelitis, prosthetic joint infections, endocarditis, and bloodstream infections. This article provides a critical reappraisal of real-world use of dalbavancin for off-label indications. A search strategy using specific keywords (dalbavancin, osteomyelitis, endocarditis, long-term suppressive therapy, bloodstream infection, pharmacokinetic/pharmacodynamic profile) until April 2021 was performed on the PubMed-MEDLINE database. As for other novel antibiotics, a conundrum between approved indications and potential innovative therapeutic uses has emerged for dalbavancin as well. The promising efficacy in challenging scenarios (i.e., osteomyelitis, endocarditis, prosthetic joint infections), coupled with the unique pharmacokinetic/pharmacodynamic properties, makes dalbavancin a valuable alternative to daily in-hospital intravenous or outpatient antimicrobial regimens in the treatment of long-term Gram-positive infections. This makes dalbavancin valuable in the current COVID-19 scenario, in which hospitalization and territorial medicine empowerment are unavoidable.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Infectious Diseases Clinic, University Hospital "Tor Vergata", Rome, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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The Antibacterial Activity of Human Amniotic Membrane against Multidrug-Resistant Bacteria Associated with Urinary Tract Infections: New Insights from Normal and Cancerous Urothelial Models. Biomedicines 2021; 9:biomedicines9020218. [PMID: 33672670 PMCID: PMC7924402 DOI: 10.3390/biomedicines9020218] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/31/2022] Open
Abstract
Urinary tract infections (UTIs) represent a serious global health issue, especially due to emerging multidrug-resistant UTI-causing bacteria. Recently, we showed that the human amniotic membrane (hAM) could be a candidate for treatments and prevention of UPEC and Staphylococcus aureus infections. However, its role against multidrug-resistant bacteria, namely methicillin-resistant S. aureus (MRSA), extended-spectrum beta-lactamases (ESBL) producing Escherichia coli and Klebsiella pneumoniae, vancomycin-resistant Enterococci (VRE), carbapenem-resistant Acinetobacter baumannii, and Pseudomonas aeruginosa has not yet been thoroughly explored. Here, we demonstrate for the first time that the hAM homogenate had antibacterial activity against 7 out of 11 tested multidrug-resistant strains, the greatest effect was on MRSA. Using novel approaches, its activity against MRSA was further evaluated in a complex microenvironment of normal and cancerous urinary bladder urothelia. Even short-term incubation in hAM homogenate significantly decreased the number of bacteria in MRSA-infected urothelial models, while it did not affect the viability, number, and ultrastructure of urothelial cells. The hAM patches had no antibacterial activity against any of the tested strains, which further exposes the importance of the hAM preparation. Our study substantially contributes to basic knowledge on the antibacterial activity of hAM and reveals its potential to be used as an antibacterial agent against multidrug-resistant bacteria.
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Schranz A, Barocas JA. Infective Endocarditis in Persons Who Use Drugs: Epidemiology, Current Management, and Emerging Treatments. Infect Dis Clin North Am 2020; 34:479-493. [PMID: 32782097 PMCID: PMC7945002 DOI: 10.1016/j.idc.2020.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infective endocarditis associated with injection drug use (IDU-IE) is markedly increasing in the United States and Canada. Long-term outcomes are dismal and stem from insufficient substance use disorder treatment. In this review, we summarize the principles of antimicrobial and surgical management for infective endocarditis associated with injection drug use. We discuss approaches to opioid use disorder care and harm reduction in the inpatient setting and review opportunities to address preventable infections among persons injecting drugs. We highlight barriers to implementing optimal treatment and consider novel approaches that may reshape infective endocarditis associated with injection drug use treatment in coming years.
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Affiliation(s)
- Asher Schranz
- Division of Infectious Diseases, University of North Carolina-Chapel Hill, 130 Mason Farm Road (Bioinformatics), CB #7030, Chapel Hill, NC 27599-7030, USA. https://twitter.com/asherjs
| | - Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
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